Protecting procedural care—cybersecurity considerations for robotic surgery
Cybersecurity is an increasingly important concern for reliable healthcare delivery and is particularly salient for robotic surgery. Surgical robots are complex systems with numerous points of vulnerability, and there have been real-world demonstrations of successful cyberattacks on surgical robots....
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| Vydané v: | NPJ digital medicine Ročník 5; číslo 1; s. 148 - 3 |
|---|---|
| Hlavní autori: | , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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London
Nature Publishing Group UK
20.09.2022
Nature Publishing Group Nature Portfolio |
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| ISSN: | 2398-6352, 2398-6352 |
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| Abstract | Cybersecurity is an increasingly important concern for reliable healthcare delivery and is particularly salient for robotic surgery. Surgical robots are complex systems with numerous points of vulnerability, and there have been real-world demonstrations of successful cyberattacks on surgical robots. There are several ways to improve the risk profile of robotic surgery, including recognizing system complexity, investing in regular software updates, following cybersecurity best-practices, and increasing transparency for all stakeholders. As robotic surgery continues to technologically advance, ensuring overall system safety from a cybersecurity perspective is paramount. |
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| AbstractList | Cybersecurity is an increasingly important concern for reliable healthcare delivery and is particularly salient for robotic surgery. Surgical robots are complex systems with numerous points of vulnerability, and there have been real-world demonstrations of successful cyberattacks on surgical robots. There are several ways to improve the risk profile of robotic surgery, including recognizing system complexity, investing in regular software updates, following cybersecurity best-practices, and increasing transparency for all stakeholders. As robotic surgery continues to technologically advance, ensuring overall system safety from a cybersecurity perspective is paramount. |
| ArticleNumber | 148 |
| Author | Landman, Adam Gordon, William J. Ikoma, Naruhiko Lyu, Heather Jackson, Gretchen Purcell |
| Author_xml | – sequence: 1 givenname: William J. orcidid: 0000-0002-6975-3225 surname: Gordon fullname: Gordon, William J. email: wjgordon@partners.org organization: Department of Medicine, Brigham and Women’s Hospital, Mass General Brigham, Department of Biomedical Informatics, Harvard Medical School – sequence: 2 givenname: Naruhiko surname: Ikoma fullname: Ikoma, Naruhiko organization: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center – sequence: 3 givenname: Heather surname: Lyu fullname: Lyu, Heather organization: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center – sequence: 4 givenname: Gretchen Purcell surname: Jackson fullname: Jackson, Gretchen Purcell organization: Department of Pediatric Surgery, Pediatrics, Biomedical Informatics, Vanderbilt University Medical Center, Intuitive Surgical, Inc – sequence: 5 givenname: Adam orcidid: 0000-0002-2166-0521 surname: Landman fullname: Landman, Adam organization: Mass General Brigham, Department of Emergency Medicine, Brigham and Women’s Hospital |
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| Cites_doi | 10.1056/NEJMp1407326 10.1002/aisy.201900138 10.1186/s12911-020-01161-7 10.1056/NEJMp1006602 10.1016/j.media.2021.102306 10.1007/s00464-021-08478-y 10.4103/0972-9941.195565 10.1001/jamanetworkopen.2019.18911 10.1063/pt.5.028828 10.1056/NEJMp1707212 10.1109/ICMLA.2018.00100 10.1007/s11548-015-1305-z 10.1097/SIH.0000000000000596 10.1016/j.clsr.2021.105528 10.1109/COGSIMA.2017.7929597 10.1097/SLA.0000000000003915 |
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| References_xml | – reference: ThaiMTAdvanced intelligent systems for surgical roboticsAdv. Intell. Syst.20202190013810.1002/aisy.201900138 – reference: BarbashGIGliedSANew technology and health care costs–the case of robot-assisted surgeryN. Engl. J. Med.20103637017041:CAS:528:DC%2BC3cXhtVCrsbvJ10.1056/NEJMp1006602 – reference: StringfieldSBExperience with 10 years of a robotic surgery program at an Academic Medical CenterSurg. Endosc.2022361950196010.1007/s00464-021-08478-y – reference: FDA. Cybersecurity in Medical Devices: Quality System Considerations and Content of Premarket Submissions Draft Guidance for Industry and Food and Drug Administration Staff. https://www.fda.gov/media/119933/download (FDA, 2022). – reference: Clark, G. W., Doran, M. V. & Andel, T. R. Cybersecurity issues in robotics. in 2017 IEEE Conference on Cognitive and Computational Aspects of Situation Management (CogSIMA) 1–5. https://doi.org/10.1109/COGSIMA.2017.7929597 (2017). – reference: Skahill, E. & West, D. Why hospitals and healthcare organizations need to take cybersecurity more seriously. https://www.brookings.edu/blog/techtank/2021/08/09/why-hospitals-and-healthcare-organizations-need-to-take-cybersecurity-more-seriously/ (2021). – reference: Maier-HeinLSurgical data science—from concepts toward clinical translationMed. Image Anal.20227610230610.1016/j.media.2021.102306 – reference: NigrinDJWhen ‘Hacktivists’ target your hospitalN. Engl. J. Med.201437139339510.1056/NEJMp1407326 – reference: SheetzKHClaflinJDimickJBTrends in the adoption of robotic surgery for common surgical proceduresJAMA Netw. Open20203e191891110.1001/jamanetworkopen.2019.18911 – reference: Shvets, A. A., Rakhlin, A., Kalinin, A. A. & Iglovikov, V. I. Automatic Instrument Segmentation in Robot-Assisted Surgery using Deep Learning. in 2018 17th IEEE International Conference on Machine Learning and Applications (ICMLA) 624–628. https://doi.org/10.1109/ICMLA.2018.00100 (2018). – reference: Intuitive. Da VinciSoftware Integrating your da Vinci experience. https://www.intuitive.com/en-us/products-and-services/da-vinci/software (2022). – reference: Bonaci, T. et al. To make a robot secure: an experimental analysis of cyber security threats against teleoperated surgical robots. http://arxiv.org/abs/1504.04339 (2015). – reference: KassahunYSurgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actionsInt. J. Comput. Assist. Radiol. Surg.20161155356810.1007/s11548-015-1305-z – reference: Posey, C. & Shoss, M. Research: Why Employees Violate Cybersecurity Policies. (Harvard Business Review, 2022). – reference: ArgawSTCybersecurity of hospitals: discussing the challenges and working towards mitigating the risksBMC Med. Inform. Decis. Mak.20202010.1186/s12911-020-01161-7 – reference: HIMSS. 2020 HIMSS Cybersecurity Survey. https://www.himss.org/sites/hde/files/media/file/2020/11/16/2020_himss_cybersecurity_survey_final.pdf (HIMSS, 2020). – reference: FDA. Firmware Update to Address Cybersecurity Vulnerabilities Identified in Abbott’s (formerly St. Jude Medical’s) Implantable Cardiac Pacemakers: FDA Safety Communication. https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm573669.htm (FDA, 2018). – reference: Osborne, C. Critical vulnerabilities uncovered in hospital robots. ZDNethttps://www.zdnet.com/article/critical-vulnerabilities-uncovered-in-medical-robots/ (2022). – reference: FDA. Postmarket Management of Cybersecurity in Medical Devices: Guidance for Industry and Food and Drug Administration Staff. https://www.fda.gov/media/95862/download (FDA, 2016). – reference: GordonWJFairhallALandmanAThreats to information security—public health implicationsN. Engl. J. Med.201737770770910.1056/NEJMp1707212 – reference: GkegkesIDMamaisIAIavazzoCRobotics in general surgery: a systematic cost assessmentJ. Minimal Access Surg.20171324325510.4103/0972-9941.195565 – reference: HHS. Understanding Patient Safety Confidentiality. https://www.hhs.gov/about/agencies/asa/ocio/hc3/index.html (2022). – reference: MelnykRDesign and implementation of an emergency undocking curriculum for robotic surgerySimul. Healthc. J. Soc. Simul. Healthc.202217788710.1097/SIH.0000000000000596 – reference: Fosch-VillarongaEMahlerTCybersecurity, safety and robots: Strengthening the link between cybersecurity and safety in the context of care robotsComput. Law Secur. Rev.20214110552810.1016/j.clsr.2021.105528 – reference: MuaddiHClinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): a systematic overview of reviewsAnn. Surg.202127346747310.1097/SLA.0000000000003915 – volume: 371 start-page: 393 year: 2014 ident: 693_CR3 publication-title: N. Engl. J. Med. doi: 10.1056/NEJMp1407326 – volume: 2 start-page: 1900138 year: 2020 ident: 693_CR9 publication-title: Adv. Intell. Syst. doi: 10.1002/aisy.201900138 – volume: 20 year: 2020 ident: 693_CR20 publication-title: BMC Med. Inform. Decis. Mak. doi: 10.1186/s12911-020-01161-7 – volume: 363 start-page: 701 year: 2010 ident: 693_CR7 publication-title: N. Engl. J. Med. doi: 10.1056/NEJMp1006602 – volume: 76 start-page: 102306 year: 2022 ident: 693_CR16 publication-title: Med. Image Anal. doi: 10.1016/j.media.2021.102306 – volume: 36 start-page: 1950 year: 2022 ident: 693_CR8 publication-title: Surg. Endosc. doi: 10.1007/s00464-021-08478-y – volume: 13 start-page: 243 year: 2017 ident: 693_CR11 publication-title: J. Minimal Access Surg. doi: 10.4103/0972-9941.195565 – ident: 693_CR19 – volume: 3 start-page: e1918911 year: 2020 ident: 693_CR6 publication-title: JAMA Netw. Open doi: 10.1001/jamanetworkopen.2019.18911 – ident: 693_CR25 – ident: 693_CR13 doi: 10.1063/pt.5.028828 – ident: 693_CR23 – ident: 693_CR14 – ident: 693_CR12 – ident: 693_CR4 – volume: 377 start-page: 707 year: 2017 ident: 693_CR2 publication-title: N. Engl. J. Med. doi: 10.1056/NEJMp1707212 – ident: 693_CR15 doi: 10.1109/ICMLA.2018.00100 – volume: 11 start-page: 553 year: 2016 ident: 693_CR17 publication-title: Int. J. Comput. Assist. Radiol. Surg. doi: 10.1007/s11548-015-1305-z – volume: 17 start-page: 78 year: 2022 ident: 693_CR21 publication-title: Simul. Healthc. J. Soc. Simul. Healthc. doi: 10.1097/SIH.0000000000000596 – volume: 41 start-page: 105528 year: 2021 ident: 693_CR5 publication-title: Comput. Law Secur. Rev. doi: 10.1016/j.clsr.2021.105528 – ident: 693_CR18 doi: 10.1109/COGSIMA.2017.7929597 – ident: 693_CR22 – ident: 693_CR24 – ident: 693_CR1 – volume: 273 start-page: 467 year: 2021 ident: 693_CR10 publication-title: Ann. Surg. doi: 10.1097/SLA.0000000000003915 |
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| SubjectTerms | 631/114/2405 706/703/559 Biomedicine Biotechnology Comment Cybersecurity Digital technology Medical technology Medicine Medicine & Public Health Patient safety Robotic surgery |
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| Title | Protecting procedural care—cybersecurity considerations for robotic surgery |
| URI | https://link.springer.com/article/10.1038/s41746-022-00693-8 https://www.proquest.com/docview/2715927929 https://www.proquest.com/docview/2716525405 https://pubmed.ncbi.nlm.nih.gov/PMC9489690 https://doaj.org/article/3484d8e03104483ea3a519fe1633e3ea |
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